- Enrollment id
- O20190212000295
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1225504855
- Multiple npi flag
- N
- Ccn
- 525663
- Associate id
- 6709124068
- Organization name
- AJ OPERATIONS LLC
- Doing business as name
- AUTUMN LAKE HEALTHCARE AT BELOIT
- Incorporation date
- 2018-10-16
- Incorporation state
- NJ
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- AUTUMN LAKE HEALTHCARE AT BELOIT
- Affiliation entity name
- AUTUMN LAKE HEALTHCARE
- Affiliation entity id
- 56
- Address line 1
- 2121 PIONEER DR
- City
- BELOIT
- State
- WI
- Zip code
- 535113025